Special report and reviewHepatic Vein Pressure Gradient Reduction and Prevention of Variceal Bleeding in Cirrhosis: A Systematic Review
Section snippets
Materials and Methods
Eligible studies were randomized controlled studies or consecutive patient series, irrespective of publication status or language, in which HVPG had been measured at baseline and during follow-up to assess whether changes of HVPG are related to the risk of variceal bleeding in patients with cirrhosis with or without previous bleeding from esophageal varices, regardless of the etiology of the liver disease. Because the scope of this systematic review was to assess the effect of HVPG reduction
Results
A total of 441 articles or abstracts were retrieved. We excluded 417 references because they were clearly irrelevant references by reading the abstracts. Sixteen14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 were excluded because only 1 HVPG measurement was performed. The remaining 12 studies fulfilled the inclusion criteria.6, 8, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39 There were 4 randominzed controlled trials (RCT)6, 32, 34, 35 and 8 studies reporting on consecutive series of
Discussion
This systematic review provides strong evidence that, in cirrhotic patients with portal hypertension, the reduction of HVPG to ≤12 mm Hg or by ≥20% of the baseline value significantly reduces the risk of bleeding, and, most importantly, a reduction of HVPG ≥20% of baseline reduces the risk of death. The effect of reducing HVPG to ≤12 mm Hg on the bleeding risk was consistent across all the studies, with 628 patients available for the analysis and without statistical heterogeneity. The odds
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Supported in part by grants from Instituto de Salud Carlos III (FIS 04/0655 and RNIHG C03/02).